Please Note the following:

Federal Law requires us to use our best efforts to collect and report the name, mailing address,
occupation and name of employer of individuals whose contributions exceed $200 in a calendar year.

Contributions submitted with this form will be used to influence Federal and State Elections, and as such are subject to the
Federal Election Campaign Act and the campaign finance laws of the State of Mississippi.

Political Contributions are not deductible for income tax purposes. We
cannot accept contributions from Corporations, Labor Unions, Foreign Nationals or in the name of
others.